Internet gaming disorder does not qualify as a mental disorder

Problematic Gaming and Gambling: A Systematic Review of Task-Specific EEG Protocols

Even though gaming and gambling bear similar problematic behavioral aspects, there are no recognizable neurophysiological biomarkers or features characterizing and/or distinguishing these conditions. A systematic review of the literature with a focus on methods was performed in PubMed, Scopus, Web of Science (Web of Science Core Collection), EBSCOhost Research Databases (APA PsycINFO; APA PsycArticles; OpenDissertations; ERIC) databases. Following search terms were used to search the databases: ERP, "event related potential*", EP, "evoked potential*", SS, "steady state", EEG, electroencephal*; gam*. Data about the participants (total number, gender, age), main aim of the study and information about the experimental setup (experimental task description, stimuli used, ERPs measured (latency windows and placement of the electrodes), process evaluated) was extracted. A total of 24 studies were revised (problematic gaming - 16, pathological gambling - 8). The experimental protocols could be grouped into 3 main target domains (Cue-reactivity, General Information processing and Reward Processes & Risk Assessment). Sample-related limitations (small sample sizes, gender differences, differences between the groups regarding potential confounding variables) and heterogeneity regarding the experimental tasks, implementation and interpretation reviewed. Gambling-related research is highly focused on the investigation of the reward-related processes, whereas gaming-related research is mostly focused on the altered aspects of more general information processing. A vast heterogeneity regarding the ERP experimental paradigms being used and lack of clear guidelines and standardized procedures prevents identification of measures capable to reliably discriminate or characterize the population susceptible to addictive behavior or being able to diagnose and monitor these disorders.

The mediating effect of after-midnight use of digital media devices on the association of internet-related addictive behavior and insomnia in adolescents

Background

There is evidence that overexposure to digital media devices (DMD) can not only lead to addictive patterns of internet use, but also cause insomnia symptoms. The aim of this cross-sectional study among adolescents is to provide an estimate of the prevalence of sleep impairments and to explore the mediating role of after-midnight use of DMD between internet-related addictive behavior (IRAB) and insomnia.

Methods

2,712 school students from Styrian schools participated in a population-representative online survey in a supervised school setting in spring 2022. School students were screened using established and validated scales. Data analysis was carried out using multiple imputation, linear multilevel regression and mediation analysis.

Results

Prevalence estimation indicates high proportions of clinically relevant moderate [12.6% (11.3%; 14.1%)] and severe [3.6% (2.9%; 4.4%)] insomnia, with an additional 30.6% (29.0%; 32.2%) at subthreshold level. DMD are typically used after midnight an average of 1.66 (1.58; 1.75) evenings with subsequent school day per school week. Linear multilevel regression analysis shows significant associations for sleep disparities as outcome variable e.g., with generalized anxiety [b = 0.329 (0.287; 0.371)], after-midnight use of DMD [b = 0.470 (0.369; 0.572)] and IRAB [b = 0.131 (0.097; 0.165)]. Mediation analysis shows a mediated proportion of 18.2% (13.0%; 25.0%) of the association of IRAB and insomnia by after-midnight use of DMD [Indirect effect: b = 0.032 (0.023; 0.040), direct effect: b = 0.127 (0.083; 0.170)].

Conclusions

Although the cross-sectional nature of this study limits causal inference, the results indicate a need for policies, which are already in preparation in Styria as part of a respective action plan.

The prevalence of internet gaming disorders and the associated psychosocial risk factors among adolescents in Malaysian secondary schools

Internet Gaming Disorder (IGD) has been placed under the conditions for further study segment in DSM-5. The purpose of the current study was to develop a preliminary psychosocial model as a reference for providing appropriate intervention, particularly for adolescents with IGD. A total of 5290 adolescents from secondary schools in seven states in Malaysia were recruited by using proportionate random sampling. A standardized set of validated questionnaires such as DASS-21, BIS-11, and IGDS9-SF were distributed to participants that fulfilled the inclusion criteria. The prevalence of IGD among Malaysian adolescents was 3.5%. The bivariate analysis summarized that factors such as stress, impulsivity, gender, time spent using the internet, and relationship with parents and friends; have statistically significant associations with IGD. The logistic regression model revealed that adolescents with IGD were 9 times more likely to experience extremely severe stress (p < 0.001). Several psychosocial factors were associated strongly with IGD in the current study, however, mental health shows the most significant issues among adolescents with IGD. Immediate intervention through a psychological approach to internet gaming is needed from parents, schools, and also respective stakeholders. IGD may become one of the addictions diseases that cause deterioration in many aspects of an adolescent's future life without serious intervention.

Gaming disorder and stigma-related judgements of gaming individuals: An online randomized controlled trial

BACKGROUND AND AIMS

The inclusion of gaming disorder (GD) in the International Classification of Diseases 11th Revision (ICD-11) has generated scholarly debate, including claims about its potential stigmatizing effects on the wider gaming population. The present study aimed to estimate the effect of addiction-based and non-addiction-based conceptualizations of problem gaming on stigma of gamers.

DESIGN

This preregistered experiment involved a 2 (health information: addiction-related or non-addiction-related) × 3 (vignette: problem, regular or casual gamer) randomized, between-subjects design.

SETTING

An international sample of participants was recruited via Prolific in June and July 2021.

PARTICIPANTS

Participants were eligible (n = 1228) if they were aged 35 to 50 years, played video games for no more than 6 hours per week and did not endorse DSM-5 or ICD-11 criteria for GD.

INTERVENTION AND COMPARATOR

Participants were provided with an explanation of problem gaming as related to either an addictive disorder (i.e. 'addiction' explanation) or personal choice and lifestyle factors (i.e. 'non-addiction' explanation).

MEASUREMENTS

The Attribution Questionnaire (AQ) and Universal Stigma Scale (USS) assessed stigma toward each gamer vignette. Vignettes described a problem gamer (with features of GD); a regular gamer (frequent gaming; some life interference); and a casual gamer (infrequent gaming; no life interference).

FINDINGS

Problem gamer vignettes (mean [M] = 113.3; 95% CI = 111.5-115.4) received higher AQ stigma ratings than regular (M = 94.0; 95% CI = 91.9-95.9) and casual gamers (M = 80.1; 95% CI = 78.2-82.1). Although significant, the effect of health information type on AQ stigma ratings was negligible (addiction group [M = 97.6; 95% CI = 95.9-99.1], non-addiction group [M = 94.1; 95% CI = 92.6-95.8]). However, the addiction information group scored lower on USS blame and responsibility than the non-addiction information group with at least a small effect (99.1% confidence).

CONCLUSIONS

Framing of problem gaming as an addictive disorder or non-addictive activity appears to have a negligible effect on stigma of different gamers among middle-age adults with minimal gaming experience. The concept of 'gaming addiction' seems unlikely to be an important influence on public stigma of gaming.

Which is more stable and specific: DSM-5 internet gaming disorder or ICD-11 gaming disorder? A longitudinal study

AIM

The high comorbidity rates of internet gaming disorder (IGD) and gaming disorder (GD) with other psychiatric disorders are concerning. A follow-up study of gamers from clinical and nonclinical samples with and without diagnoses of IGD or GD was conducted to investigate the changes in diagnoses over a 1-year period, compare their diagnostic stability, and examine the patterns of co-occurrence between IGD and GD with other psychiatric disorders over the same period.

METHODS

Baseline and 1-year follow-up data of 279 participants, including 120 problematic gaming patients and 159 gamers from the general population, were analyzed. Information on demographics, gaming habits, and self-reported psychological status was collected. Additionally, a structured interview was conducted using the Gaming Diagnostic Interview and the Mini-International Neuropsychiatric Interview.

RESULTS

Although there was no significant difference between the changes in IGD/GD diagnosis during the 1-year period, 34.7% of the participants had a change in IGD diagnosis, while the number of GD cases increased to 60.4%. When evaluating the fixed effects of comorbidity on IGD and GD, attention-deficit/hyperactivity disorder had the highest odds ratio for both IGD (75.23; 95% confidence interval [CI], 10.67-530.61) and GD (117.02 × 10⁶ ; 95% CI, 2.23 × 10⁶ -6132.64 × 10⁶ ).

CONCLUSION

These results reveal that a GD diagnosis might be more prone to change than an IGD diagnosis. GD was also found to be more affected by comorbid psychiatric disorders.

Different Typologies of Gamers Are Associated with Mental Health: Are Students DOOMed?

(1) Background: The inclusion of Internet Gaming Disorder in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) led to a rapid development of assessment instruments based on the suggested diagnosis. However, previous studies suggest that some of the symptoms in the diagnosis reflect engagement in gaming rather than a disorder or addiction. The aim of the present cross-sectional study was to investigate mental health associations with different typologies of gamers. (2) Methods: Data stemmed from a large national survey of students (SHoT2022) that was conducted between February and April 2022 (N = 59,544). Participants were categorized into non-gamers, recreational gamers, engaged gamers, problematic gamers, and addicted gamers. Logistic regression models adjusted for age were analyzed with and without gender-stratification for mental distress and life satisfaction as dependent variables across gaming categories. (3) Results: The proportion reporting case-level mental distress was lower for recreational gamers compared to non-gamers, indicating fewer mental health problems for recreational gamers. However, after stratifying the analysis by gender, female recreational gamers had higher levels of mental distress compared to female non-gamers, reflecting Simpson's paradox. (4) Conclusions: Future studies investigating mental health and gaming should include a gender perspective.

Screening for media use in the ED among young Australians: a cross-sectional study (Preprint)

BACKGROUND

Research on problematic internet use has largely adhered to addiction paradigms, possibly impeding the identification of specific internet behaviors related to psychopathology. This study presents a novel approach to screening for specific problematic internet behaviors by using a new measure, the emergency department media use screener (EDMUS).

OBJECTIVE

The purpose of this study was to identify patterns of internet use in young people presenting with mental health concerns to the emergency department (ED), ascertain associations with their mental health, and evaluate whether the EDMUS can be used to predict subsequent ED presentations within 3 months.

METHODS

This cross-sectional retrospective study of Australian young people (N=149, aged 11-25 years; female: n=92, 61.7%) sought to use the EDMUS, a 24-item questionnaire, to identify problematic internet behaviors, including accessing or posting prosuicidal or proeating disorder content, cyberbullying, and inappropriate digital content. Data on each person's mental health were extracted from electronic medical records to look for associations with EDMUS responses and ED re-presentation over 3 months. EDMUS items were grouped into clusters for analysis using chi-square tests, binary logistic regression, and path analyses.

RESULTS

Sharing suicidal digital content was the most common problematic internet use pattern identified by the EDMUS. However, this did not correlate with having a prior mental health diagnosis or predict readmission. Most participants had families with a concern for their internet use; however, this was less likely in participants with a diagnosis of personality disorder. Diagnoses of personality disorder or posttraumatic stress disorder were independent predictors of readmission (P=.003; P=.048).

CONCLUSIONS

Although a history of complex psychopathology increases the likelihood of subsequent ED presentations, its links to internet use-related behaviors are still unclear. The EDMUS has potential for identifying young people who are most vulnerable to problematic internet behaviors and offers the opportunity for early intervention and potential prevention of more entrenched difficulties.

Proton magnetic resonance spectroscopy (MRS) in individuals with internet gaming

BACKGROUND

Various comorbid psychiatric diagnoses, including attention deficit hyperactivity disorder (ADHD), have been reported in individuals with internet gaming disorder (IGD). Prior research has shown alterations in brain metabolites, including N-acetylaspartate (NAA), and combined glutamate and glutamine in patients with ADHD that were similar to those observed in patients with IGD. We hypothesized that the decreased NAA levels in the IGD group would be associated with a history of ADHD.

METHODS

Forty adults participated in this study. Participants were classified as having a high risk for IGD if they had a total score higher than 21 on the IGD Scale-short form. Proton magnetic resonance spectroscopy (¹H-MRS) and high-resolution structural magnetic resonance imaging (MRI) data were acquired using a 3 Tesla Siemens Prisma scanner system.

RESULTS

Levels of NAA within the right prefrontal cortex were lower in the IGD group than those observed in the control group. In a multiple linear regression analysis, internet addiction test scores and history of ADHD were shown to predict increased game play. In addition, history of ADHD predicted lower levels of NAA within the right prefrontal cortex.

CONCLUSION

The preliminary results of current study suggest a mediating effect of ADHD on the severity of internet game play as well as the levels of NAA within the dorsolateral prefrontal cortex (DLPFC). The inclusion of ADHD in IGD research is important and deserving of further consideration.

Diminished cognitive control in Internet gaming disorder: A multimodal approach with magnetic resonance imaging and real-time heart rate variability

OBJECTIVE

Recently, the addiction to online games, classified as Internet gaming disorder (IGD) on DSM-V, has emerged as an important mental health problem. The loss of control over gaming in IGD is associated with diminished cognitive control. This study aimed to link the neurobiological mechanism reflected by brain imaging and the diminished cognitive control reflected by heart rate variability (HRV) measurements during real-time gameplay.

METHODS

HRV was assessed in 33 young males with IGD and 29 controls while playing their favorite games. Seed-based functional connectivity (FC) was evaluated in the dorsolateral prefrontal cortex, anterior cingulate cortex, and dorsal striatum. Associations between HRV and alterations in FC were tested.

RESULTS

Individuals with IGD showed a reduction of high-frequency HRV during real-time gaming, which is correlated with self-reported severity of IGD. Subjects with IGD showed decreased FC between the right dorsolateral prefrontal cortex and the right inferior frontal gyrus, corresponding to the cognitive control network. They showed decreased FC between the right anterior cingulate cortex and the superior parietal lobule. They also showed increased FC between the left dorsal putamen and the postcentral gyrus, corresponding to the sensorimotor network. Game-related high-frequency HRV was correlated with dorsolateral prefrontal cortex-inferior frontal gyrus connectivity.

CONCLUSION

The diminished cognitive control reflected by HRV measurements during real-time gameplay was associated with FC alterations, involving a weak FC in the cognitive control network. Individuals with IGD may have less cognitive control, particularly when playing games, and consequently end up playing games in a habitual manner rather than in a goal-oriented manner.

Latent Profile of Internet and Internet Game Usage Among South Korean Adolescents During the COVID-19 Pandemic

Introduction: Globally, more people are spending time on the Internet and gaming since the outbreak of the Coronavirus Disease 2019 (COVID-19). Consequently, concerns about developing behavioral addiction of adolescents have been raised. Such risk could be greater for adolescents in South Korea where the majority of adolescents have access to the Internet and own a smartphone. In fact, statistics indicate that Korean youths are spending significantly more time on the Internet and gaming during the COVID-19 pandemic. Previous studies on the patterns of time spent on the Internet and Internet gaming show inconsistent results. The aim of this study is to investigate the latent profiles of the Internet and Internet game usage among adolescents in South Korea. Method: Data from a national survey on elementary and middle school students across South Korea were used. The sample consists of 3,149 respondents, and 2,984 responses were analyzed after removing missing responses. Latent profile analysis was performed to investigate the number of latent profiles for the Internet and Internet game usage time. To validate the profiles, differences in problematic gaming behavior, sex, and neuroticism were examined. Results: Seven profiles were found: Casual User, Moderate User, Smartphone User, Internet User, PC Internet Gamer, Heavy User, and Excessive User. Validation of the profiles indicated differences in problematic gaming behavior, sex, and neuroticism among selected profiles. Conclusion: This study presented different profiles of the Internet and Internet game usage among adolescents in South Korea. Profiles with higher game usage time scored higher in problematic game use compared to other profiles. Males were more likely to be in the profiles with high gaming time, and females were more likely to be in Internet and Smartphone User profiles. The results indicate that Internet and Internet gaming usage patterns could be classified by the type of device used and the content of the Internet.

Evaluating the Social Cost of Conflict between New Media and Society: The Case of Gaming Disorder in South Korea

Historically, the introduction of a new media in mass market caused a strong conflict starting from the nineteenth century popular literature, comics, rock music and film. Interestingly, these conflicts have shown similar and repeated patterns, which is now called media panic and moral regulation, and games are following this pattern. In 2019, Gaming disorder (GD) was decided to be included in the International Classification of Diseases (ICD-11), and similar conflicts on games arenow expected. However, the social cost and damage have not been fully addressed until now. Thus, this study focuses on the estimation of the social cost induced by GD for policy design and decisions in the public healthcare of South Korea. Using the contingent valuation method, a popular valuation method in econometrics for non-market goods, this study has tried to estimate the social cost induced by the introduction of GD into the public healthcare practice. Focusing on a false positive problem in the diagnosis, this study estimates that the willingness to pay for GD diagnosis for children is about KRW 152 K (USD 135). Considering the difference between the prevalence of GD (1.9%) and GD suspicion rate of children in the respondents (12.54%), the excessive medical diagnosis cost due to the false positive problem is estimated to KRW 101 billion (USD 89.6 M), which is about four times more than the annual medical cost for Attention Deficit Hyperactivity Disorder (ADHD) treatment in South Korea. Thus, strong scientific proof and a cautious policy approach on GD are needed before the inclusion of GD in the public health practice.

Person-centred interventions for problem gaming: a stepped care approach

BACKGROUND

Problem gaming is reported by approximately 1-3% of the population and is associated with decreased health and wellbeing. Research on optimal health responses to problem gaming remains limited. This study aimed to identify and describe the key components of a person-centred approach to interventions for problem gaming for individuals who voluntary seek assistance.

METHODS

Online interviews were conducted with 20 adults (90% male; M_age = 23y) currently seeking help for problem gaming. The interview protocol was guided by a health care access framework which investigated participants' experiences and needs related to accessing professional support. Transcripts were analysed in NVivo using qualitative content analysis to systematically classify participant data into the themes informed by this framework.

RESULTS

Participants had mixed views on how the negative consequences of problem gaming could be best addressed. Some indicated problems could be addressed through self-help resources whereas others suggested in-person treatment with a health professional who had expertise in gaming. Participants described the essential components of an effective health service for problem gaming as including: valid and reliable screening tools; practitioners with specialist knowledge of gaming; and access to a multimodal system of intervention, including self-help, internet and in-person options that allow gamers to easily transition between types and intensity of support.

CONCLUSION

A comprehensive health care approach for interventions for problem gaming is in its infancy, with numerous service access and delivery issues still to be resolved. This study highlights the importance of involving individuals with gaming-related problems in developing solutions that are fit for purpose and address the spectrum of individual preferences and needs. These findings recommend a stepped healthcare system that adheres to evidence-based practice tailored to each individual and the implementation of standard assessment and routine outcome monitoring.

Prevention Strategies to Address Problematic Gaming: An Evaluation of Strategy Support Among Habitual and Problem Gamers

Psychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers' level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.

Can Worried Parents Predict Effects of Video Games on Their Children? A Case-Control Study of Cognitive Abilities, Addiction Indicators and Wellbeing

Many parents worry over their children’s gaming habits, but to what extent do such worries match any detrimental effects of excessive gaming? We attempted to answer this question by comparing children of highly concerned parents with other adolescents of the same age. A cohort of parents who identified as highly concerned over their children’s video game habits were recruited for a public study in collaboration with a national television network. Using an online experimental platform in conjunction with surveys of parents’ beliefs and attitudes, we compared their children to age-matched peers in an exploratory case-control study. The scores of children with highly concerned parents on tests of cognitive control (cued task-switching and Iowa Gambling Task) and psychological wellbeing (WHO-5) were statistically similar to controls, suggesting no selective cognitive or psychological detriments from gaming or otherwise in the cases with concerned parents. The case group, however, did spend more time gaming, and scored higher than controls on problem gaming indicators (Gaming Addiction Scale), which also correlated negatively with wellbeing. Within the case group, wellbeing effects seemed mainly to consist in issues of relaxation and sleep, and related to gaming addiction indicators of playing to forget real-world problems, and the feeling of neglecting non-gaming activities. Where most results of research staged for TV never get published, making it difficult to interpret both methods and results, this paper describes findings and participant recruitment in detail. The relationship between parental concern and children’s gaming is discussed, as is the merits and challenges of research conducted with media, such as TV programs and their recruited on-screen participants.

Monetary Reward Discounting, Inhibitory Control, and Trait Impulsivity in Young Adults With Internet Gaming Disorder and Nicotine Dependence

Internet Gaming Disorder (IGD) has been considered a potential behavioral or non-substance addiction that requires further investigation. Recognition of the commonalities between IGD and Substance Use disorders (SUD) would be of great help to better understand the basic mechanisms of addictive behaviors and excessive Internet gaming. However, little research has targeted a straightforward contrast between IGD and SUD on neuropsychological aspects. The present study thus aimed to explore the associations of reward processing and inhibitory control with IGD and nicotine dependence (ND) in young adults. Fifty-eight IGD and 53 ND individuals, as well as 57 age- and gender-matched healthy controls, were assessed with a series of measurements including the Delay-discounting Test (DDT), Probability Discounting Test (PDT), the Stroop Color-Word Task, a revised Go/No Go Task, and the Barratt Impulsiveness Scale (BIS-11). Multivariate analysis of variance (mANOVA) models revealed that both IGD and ND groups scored higher than healthy controls on the BIS-11 attentional, motor, and non-planning impulsiveness (Cohen's d = 0.41-1.75). Higher degrees of delay discounting on the DDT were also found in IGD and ND groups compared to healthy controls (Cohen's d = 0.53-0.69). Although IGD group did not differ from healthy controls on the PDT, ND group had a lower degree of probability discounting than healthy controls (Cohen's d = 0.55), suggesting a reduction in risk aversion. Furthermore, ND subjects showed a lower correct accuracy in the incongruent trials of the Stroop task than healthy controls (Cohen's d = 0.61). On the Go/No Go task, both IGD and ND groups had a lower correct accuracy in the No-Go trials than healthy controls (Cohen's d = 1.35-1.50), indicating compromised response inhibition. These findings suggested that IGD was linked to both anomalous reward discounting and dysfunctional inhibitory control, which was comparable with one typical SUD category (i.e., ND). This study might promote a better understanding of the pathogenesis of IGD as a potential addictive disorder similar to SUD.

A systematic review on the intersection of attention-deficit hyperactivity disorder and gaming disorder

INTRODUCTION

Studies of Gaming Disorder (GD) consistently identify co-morbidity with various psychiatric disorders including major depression, obsessive compulsive disorder and anxiety disorders. One of the strongest associations has been with Attention Deficit Hyperactivity Disorder (ADHD). We present a systematic review of this association by pooling and integrating available evidence.

METHODS

PubMed, EMBASE, PsychInfo and CINHAHL were searched for articles that reported a quantitative association between GD and ADHD and its dimensions, using equivalent search terms. Quality appraisal was done using criteria adapted from the Critical Appraisal Skills Package (CASP) checklists.

RESULTS

1028 articles were identified, of which 29 studies were included for systematic review (n = 56650 participants). Most of these studies were observational in nature, and were of moderate quality, with deficits particularly in the domains of generalisability and confounding. Community surveys (n = 18) of purposive samples constituted the majority, with fewer clinic-based samples (n = 11). While ADHD symptoms were consistently associated with GD, More frequent associations were displayed with inattention associations with GD than other ADHD subscales. There were no conclusive findings regarding the type of game on severity of either condition, or on completion of treatment.

CONCLUSIONS

The findings suggest an association between ADHD and GD, although the direction of the relationship is unclear. This has implications for clinical practice, policy and research. We recommend that ADHD is screened for when evaluating IGD as part of routine practice."

Internet gaming disorder and gaming disorder in the context of seeking and not seeking treatment for video-gaming

The aims of this study were to examine the relationship between Internet gaming disorder (IGD) and gaming disorder (GD) and the degree of concordance between treatment seeking for gaming and IGD/GD. One hundred gamers who sought treatment for their gaming were compared with one hundred gamers who never sought treatment and gamers who met IGD and/or GD criteria were compared with those who did not meet these criteria, regardless of their treatment-seeking status. These comparisons were made using semi-structured diagnostic interviews and self-report psychopathology and symptom measures. There was only a partial concordance between treatment seeking and IGD/GD because 61% of treatment-seeking gamers met the diagnostic criteria for IGD and 36% met the diagnostic criteria for GD. GD criteria were found to reflect a more intense, pathological pattern of gaming, associated with high rates of attention deficit/hyperactivity disorder (ADHD) and coping as the main reason for gaming. IGD criteria were found to refer to a broad, heterogeneous entity that encompasses a "spectrum" of gaming from risky/hazardous to pathological. These findings suggest that gamers may seek treatment for IGD/GD, a diagnostically subthreshold, risky gaming pattern (i.e., hazardous gaming) or for a gaming pattern that seems normal. A partial overlap between IGD and GD indicates that the two disorders as conceptualized by their respective criteria, should not be considered interchangeably. The relationship and extent of the conceptual overlap between ADHD and a gaming-related disorder, especially GD, merit further study.

Which conditions should be considered as disorders in the International Classification of Diseases (ICD-11) designation of "other specified disorders due to addictive behaviors"?

BACKGROUND

Gambling and gaming disorders have been included as "disorders due to addictive behaviors" in the International Classification of Diseases (ICD-11). Other problematic behaviors may be considered as "other specified disorders due to addictive behaviors (6C5Y)."

METHODS

Narrative review, experts' opinions.

RESULTS

We suggest the following meta-level criteria for considering potential addictive behaviors as fulfilling the category of "other specified disorders due to addictive behaviors":1. Clinical relevance: Empirical evidence from multiple scientific studies demonstrates that the specific potential addictive behavior is clinically relevant and individuals experience negative consequences and functional impairments in daily life due to the problematic and potentially addictive behavior.2. Theoretical embedding: Current theories and theoretical models belonging to the field of research on addictive behaviors describe and explain most appropriately the candidate phenomenon of a potential addictive behavior.3. Empirical evidence: Data based on self-reports, clinical interviews, surveys, behavioral experiments, and, if available, biological investigations (neural, physiological, genetic) suggest that psychological (and neurobiological) mechanisms involved in other addictive behaviors are also valid for the candidate phenomenon. Varying degrees of support for problematic forms of pornography use, buying and shopping, and use of social networks are available. These conditions may fit the category of "other specified disorders due to addictive behaviors".

CONCLUSION

It is important not to over-pathologize everyday-life behavior while concurrently not trivializing conditions that are of clinical importance and that deserve public health considerations. The proposed meta-level-criteria may help guide both research efforts and clinical practice.

How have excessive electronics devices and Internet uses been concerned? Implications for global research agenda from a bibliometric analysis

BACKGROUND AND AIMS

Excessive use of electronic devices has become a major global problem. However, little is known about the development and current landscape of research concerning this field. This study aimed at exploring the overall publication trend and topics of research on the overuse of electronic devices and the Internet from 1971 to 2017.

METHODS

We systematically searched the Web of Science (WoS) and Scopus databases for published articles on the excessive use of electronic devices and the Internet. Data regarding the publication volume, international collaborations, and geographical locations were analyzed by bibliometrics analysis. Latent Dirichlet Allocation (LDA) was undertaken to categorize publications into different research topics.

RESULTS

A total of 2,276 papers from the WOS and 600 papers from the Scopus were included. We found a dramatic increase in the number of scientific papers towards addiction to electronic devices and the Internet. The United State led in all publication parameters including the total number of papers and total citations. China, Korea and Taiwan were among the most prolific countries/regions. Smartphone addiction was the main concern, and the relationship between the overuse of electronic devices and the Internet and mental health issues have been highlighted. On the other hand, our study found a limited appearance of discussion on effective treatment and intervention.

DISCUSSION AND CONCLUSION

The findings of this study call for more national and international cooperation in evaluating and intervening addiction to electronic devices and the Internet to gather more knowledge about this phenomenon and evaluate the effectiveness of treatment.

Learning to lose control: A process-based account of behavioral addiction

Learning psycho(bio)logy has developed a solid corpus of evidence and theory regarding behavior control modes. The present article briefly reviews that literature and its influence on recent models in which the transition from goal-directed to compulsive behavior is identified as the main process underlying substance use disorders. This literature is also relevant to non-substance addictive disorders, and serves as basis to propose a restricted definition of behavioral addiction relying on the presence of behavior-specific compulsivity. Complementarily, we consider whether some activities can become disordered while remaining mostly goal-driven. Based on reinforcement learning models, relative outcome utility computation is proposed as an alternative mechanism through which dysfunctional behaviors (even not qualifying as addictive) can override adaptive ones, causing functional impairment. Beyond issues of conceptual delimitation, recommendations are made regarding the importance of identifying individual etiological pathways to dysregulated behavior, the necessity of accurately profiling at-risk individuals, and the potential hazards of symptom-based diagnosis. In our view, the validity of these recommendations does not depend on the position one takes in the nosological debate.

Do gaming disorder and hazardous gaming belong in the ICD-11? Considerations regarding the death of a hospitalized patient that was reported to have occurred while a care provider was gaming

There has been much debate regarding the extent to which different types and patterns of gaming may be considered harmful from individual and public health perspectives. A recent event in which a hospitalized patient was reported to have died while a care provider was gaming is worth considering as an example as to how gaming may distract individuals from work-related tasks or other activities, with potential negative consequences. As the 11th edition of the International Classification of Diseases is being developed, events like these are important to remember when considering entities like, and generating criteria for, disordered or hazardous gaming.